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General NPI Number Information
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NPI Number | 1861620627
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Entity Type | Individual
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Provider Name | PATRICK W GAVIN D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 1100 GOETHALS DRIVE SUITE D KADLEC CLINIC UROLOGY
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City | RICHLAND
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State | WA
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Zip | 99352
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Country | US
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Telephone | 509-942-3165
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Fax | 509-942-3167
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Provider Business Mailing Address
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Address Line | 3900 S ZINTEL WAY
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City | KENNEWICK
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State | WA
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Zip | 99337-5092
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Country | US
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Telephone | 509-942-3627
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Fax | 509-942-2268
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 5101018466
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | OP60479551
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License Number State | WA
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